DESCRIPTION: Congestive heart failure (CHF) is a major cause of functional disability and decreased quality of life (QOL). People with CHF are living longer, but with disabling symptoms, in particular dyspnea, that erode health-related quality of life (HRQOL). Nursing interventions that can reduce adverse outcomes and/or improve HRQOL outcomes are needed. The purpose of this study is to determine the effects of home-based, nurse-coached inspiratory muscle training (IMT) in people with CHF. Selective IMT is a safe, cost-effective, low technology, non-invasive intervention that can be implemented easily in the home. It is postulated that if IMT is successful there will be a decrease in dyspnea, enhanced self-efficacy, and improved physical/functional and psychosocial dimensions of HTQOL. Therefore, the goals of this study are primarily to determine the effects of a three-month, home-based, nurse-coached IMT in relation to inspiratory muscle strength and dyspnea, and secondly, to determine the effects of IMT with respect to self-efficacy and physical/functional, psychosocial dimensions of HRQOL. The framework for this study is based on Bandura's Self-Efficacy Theory. The study is a two-group, randomized study with repeated measures in which data will be collected four times over a period of 12 weeks with home visits and telephone follow-up. The experimental group will receive IMT while the comparison group will receive an educational program. Accounting for a 25 percent attrition, a sample of 64 subjects will be recruited from physicians' offices and health clinics. The proposed project will target older adults, 60 years or older, community dwelling, with Class II or III CHF, with an ejection fraction of <40 percent. Data will be analyzed using MANOCA (MANOVA?) with repeated measures. The outcome variables are: inspiratory muscle strength, dyspnea, self-efficacy, and physical/functional and psychosocial dimensions of HRQOL. The outcome measures will include: PImax, Perceived Exertion Scale (Borg), Chronic Respiratory Questionnaire Dyspnea Scale (Guyatt), COPD Self-Efficacy Scale (Wigal), and the MOS SF 36 (Ware & Sherbourne).